Uncontrollable Impulses: Hard to Treat; Hard Stop

Many people have problems that occur repetitively, disrupt their lives and seem completely out of control. Sometimes we’re asked if these problems are examples of obsessive compulsive disorder (OCD). And indeed, there are some similarities to OCD. Nevertheless, these problems are not considered to be in the same category. So what are we talking about here?

Specifically, we’re referring to the category of emotional disorders known as Impulse Control Disorders. The similarity to OCD is seen in the fact that impulse control disorders, like OCD, are repetitive and very difficult for the person to bring under control. Furthermore, like OCD, they greatly disrupt and impair the sufferers’ lives.

However, Impulse Control Disorders also differ from OCD in important ways. Impulse Control Disorders, unlike OCD, often do not cause a great deal of distress to the person who has them—that is, unless or until legal authorities are called in.

Furthermore, distress, anxiety and upset do not play a very large role in most Impulse Control Disorders. In fact, many of those with Impulse Control Disorders actually report feeling pleasure from their behaviors even though their lives are impaired by them.

Some of the major types of Impulse Control Disorders include:

Pyromania: People with this problem find themselves irresistibly drawn to setting fires. They aren’t out to make money as arsonists are; rather, they set fires for the excitement of it. Unfortunately, for those afflicted with this problem, law enforcement agencies consider their behavior on a par with arsonists; in other words, they don’t cut them a lot of slack.

Kleptomania: These folks find themselves stealing repeatedly, yet they rarely need the things they steal. Rather, they feel tension prior to stealing and great pleasure and excitement when executing the theft. Later, they may feel remorse, but it such remorse fails to stop their behavior. As you can imagine, more than a few of these people eventually wind up in jail.

Pathological Gambling: Not just anyone qualifies as a pathological gambler and thus have an Impulse Control Disorder. Only those who gamble themselves into serious problems financially over and over again receive this label. These folks sometimes even steal or engage in other illegal behavior just to keep their habit going. They may “know” what they are doing is a problem, but report feeling unable to stop.

Intermittent Explosive Disorder: People with this problem report feeling unable to put the brakes on repeated episodes of aggression. They often harm property as well as people. When they feel the impulse to be aggressive, they say they “can’t help themselves.” Again, law enforcement agencies, not surprisingly, see their behavior differently.

Compulsive Buying: Though not officially recognized as an Impulse Control Disorder in the current version of professionals’ diagnostic manual, people with this problem look very much like those with other Impulsive Control Disorders. They can’t stop themselves from buying “stuff” that is frequently completely unnecessary. They do so to the extent that their finances end up in ruins. They feel great when they buy something, but that feeling is fleeting and often replaced by guilt and shame. In spite of those feelings, they continue the cycle repeatedly.

Trichotillomania: This is a common problem and involves repetitive, irresistible urges to pull out strands of hair. Sometimes Trichotillomania results in bald patches or even complete baldness. People with this problem often report feeling some pleasure from pulling hairs, whereas others say their main motivation is a reduction in anxiety or distress.

Treatment of Impulse Control Disorders has lagged behind the treatment of many other emotional disorders such as depression, anxiety, and obsessive compulsive disorder. There are some indications that treatments such as Habit Reversal Training may have value for Trichotillomania. However, most of the Impulse Control Disorders beg for more research on potential treatments.

Of course, even if we had a plethora of effective treatments, there’s still the problem that most of those with Impulse Control Disorders aren’t all that interested in getting help. Sigh.

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About Charles H. Elliott, Ph.D.

Charles H. Elliott, Ph.D. is a clinical psychologist and a Founding Fellow in the Academy of Cognitive Therapy. He is also a member of the faculty at Fielding Graduate University. He specializes in the treatment of adolescents and adults with obsessive compulsive disorder, anxiety, anger, depression, and personality disorders. Dr. Elliott is coauthor of: Overcoming Anxiety For Dummies (2nd Ed), Obsessive Compulsive Disorder For Dummies, Seasonal Affective Disorder For Dummies, Anxiety and Depression Workbook For Dummies, Depression For Dummies, Why Can't I Get What I Want?, Why Can’t I Be the Parent I Want to Be?, and Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth. His website is: http://www.psychology4people.com